AIDS and Behavior

, Volume 14, Issue 1, pp 38–47 | Cite as

Urban African-American Men Speak Out on Sexual Partner Concurrency: Findings from a Qualitative Study

  • Michael P. CareyEmail author
  • Theresa E. Senn
  • Derek X. Seward
  • Peter A. Vanable
Original Paper


Sexual partner concurrency, which fuels the spread of HIV, has been hypothesized as a cause of higher rates of HIV among low-income, urban African-Americans. Despite this hypothesis, little is known about the phenomenology of partner concurrency. To address this gap in the literature, we recruited 20 urban African-American men from a public STD clinic to elicit their ideas about partner concurrency. Five themes emerged during focus group discussions. First, there was a general consensus that it is normative to have more than one sexual partner. Second, men agreed it is acceptable for men to have concurrent partners, but disagreed about whether it is acceptable for women. Third, although men provided many reasons for concurrent partnerships, the most common reasons were that (a) multiple partners fulfill different needs, and (b) it is in a man’s nature to have multiple partners. Fourth, men described some (but not all) of the negative consequences of having concurrent partners. Finally, men articulated spoken and unspoken rules that govern concurrent partnerships. These findings increase knowledge about urban, African-American men’s attitudes toward concurrent partnerships, and can help to improve the efficacy of sexual risk-reduction interventions for this group of underserved men and their partners.


HIV/AIDS Sexually transmitted diseases Heterosexual transmission African-American Men Partner concurrency 



This research was supported by NIH grant # R01-MH068171 to Michael P. Carey. We thank all those who participated in the research, and the Health Improvement Project team members.


  1. Adimora, A. A., & Schoenbach, V. J. (2002). Contextual factors and the Black-White disparity in heterosexual HIV transmission. Epidemiology, 13, 707–712. doi: 10.1097/00001648-200211000-00016.CrossRefPubMedGoogle Scholar
  2. Adimora, A. A., & Schoenbach, V. J. (2005). Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. Journal of Infectious Diseases, 191, S115–S122. doi: 10.1086/425280.CrossRefPubMedGoogle Scholar
  3. Adimora, A. A., Schoenbach, V. J., Bonas, D. M., Martinson, F. E. A., Donaldson, K. H., & Stancil, T. R. (2002). Concurrent sexual partnerships among women in the United States. Epidemiology, 13, 320–327. doi: 10.1097/00001648-200205000-00013.CrossRefPubMedGoogle Scholar
  4. Adimora, A. A., Schoenbach, V. J., & Doherty, I. A. (2007). Concurrent sexual partnerships among men in the United States. American Journal of Public Health, 97, 2230–2237. doi: 10.2105/AJPH.2006.099069.CrossRefPubMedGoogle Scholar
  5. Adimora, A. A., Schoenbach, V. J., Martinson, F. E. A., Coyne-Beasley, T., Doherty, I., Stancil, T. R., et al. (2006). Heterosexually transmitted HIV infection among African Americans in North Carolina. Journal of Acquired Immune Deficiency Syndromes, 41, 616–623. doi: 10.1097/01.qai.0000191382.62070.a5.CrossRefPubMedGoogle Scholar
  6. Adimora, A. A., Schoenbach, V. J., Martinson, F. E. A., Donaldson, K. H., Stancil, T. R., & Fullilove, R. E. (2003). Concurrent partnerships among rural African Americans with recently reported heterosexually transmitted HIV infection. Journal of Acquired Immune Deficiency Syndromes, 34, 423–429. doi: 10.1097/00126334-200312010-00010.CrossRefPubMedGoogle Scholar
  7. Adimora, A. A., Schoenbach, V. J., Martinson, F., Donaldson, K. H., Stancil, T. R., & Fullilove, R. E. (2004). Concurrent sexual partnerships among African Americans in the rural South. Annals of Epidemiology, 14, 155–160. doi: 10.1016/S1047-2797(03)00129-7.CrossRefPubMedGoogle Scholar
  8. Buss, D. M., & Schmitt, D. P. (1993). Sexual strategies theory: An evolutionary perspective on human mating. Psychological Review, 100, 204–232. doi: 10.1037/0033-295X.100.2.204.CrossRefPubMedGoogle Scholar
  9. Carey, M. P., Vanable, P. A., Senn, T. E., Coury-Doniger, P., & Urban, M. (in press). Evaluating a two-step approach to sexual risk reduction in a publicly-funded STI clinic: Rationale, design, and baseline data from the Health Improvement Project-Rochester (HIP-R). Contemporary Clinical Trials. Google Scholar
  10. Crawford, M., & Popp, D. (2003). Sexual double standards: A review and methodological critique of two decades of research. Journal of Sex Research, 40, 13–26.CrossRefPubMedGoogle Scholar
  11. Davidovich, U., de Wit, J. B. F., & Stroebe, W. (2000). Assessing sexual risk behaviour of young gay men in primary relationships: The incorporation of negotiated safety and negotiated safety compliance. AIDS, 14, 701–706. doi: 10.1097/00002030-200004140-00009.CrossRefPubMedGoogle Scholar
  12. Doherty, I. A., Shiboski, S., Ellen, J. M., Adimora, A. A., & Padian, N. S. (2006). Sexual bridging socially and over time: A simulation model exploring the relative effects of mixing and concurrency on viral sexually transmitted infection transmission. Sexually Transmitted Diseases, 33, 368–373. doi: 10.1097/01.olq.0000194586.66409.7a.CrossRefPubMedGoogle Scholar
  13. Drumright, L. N., Gorbach, P. M., & Holmes, K. K. (2004). Do people really know their sex partners? Concurrency, knowledge of partner behavior, and sexually transmitted infections within partnerships. Sexually Transmitted Diseases, 31, 437–442. doi: 10.1097/01.OLQ.0000129949.30114.37.CrossRefPubMedGoogle Scholar
  14. Ellen, J. M., Aral, S. O., & Madger, L. S. (1998). Do differences in sexual behaviors account for the racial/ethnic differences in adolescents’ self-reported history of a sexually transmitted disease? Sexually Transmitted Diseases, 25, 125–129. doi: 10.1097/00007435-199803000-00002.CrossRefPubMedGoogle Scholar
  15. Epstein, H. (2007). The invisible cure: Africa, the West, and the fight against AIDS. New York: Farrar, Straus, & Giroux.Google Scholar
  16. Fenton, K. A., Korovessis, C., Johnson, A. M., McCadden, A., McManus, S., Wellings, K., et al. (2001). Sexual behaviour in Britain: Reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection. Lancet, 358, 1851–1854. doi: 10.1016/S0140-6736(01)06886-6.CrossRefPubMedGoogle Scholar
  17. Floyd, F. J., & Wasner, G. H. (1994). Social exchange, equity, and commitment: Structural equation modeling of dating relationships. Journal of Family Psychology, 8, 55–73. doi: 10.1037/0893-3200.8.1.55.CrossRefGoogle Scholar
  18. Ford, K., Sohn, W., & Lepkowski, J. (2002). American adolescents: Sexual mixing patterns, bridge partners, and concurrency. Sexually Transmitted Diseases, 29, 13–19. doi: 10.1097/00007435-200201000-00003.CrossRefPubMedGoogle Scholar
  19. Ghani, A., Swinton, J., & Garnett, G. P. (1997). The role of sexual partnership networks in the epidemiology of gonorrhea. Sexually Transmitted Diseases, 24, 45–56. doi: 10.1097/00007435-199701000-00009.CrossRefPubMedGoogle Scholar
  20. Gilbart, V. L., Williams, D. I., Macdonald, N. D., Rogers, P. A., Evans, B. G., Hart, G., et al. (2000). Social and behavioural factors associated with HIV seroconversion in homosexual men attending a central London STD clinic: A feasibility study. AIDS Care, 12, 49–58. doi: 10.1080/09540120047468.CrossRefPubMedGoogle Scholar
  21. Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine.Google Scholar
  22. Gorbach, P. M., Drumright, L. N., & Holmes, K. K. (2005). Discord, discordance, and concurrency: Comparing individual and partnership-level analyses of new partnerships of young adults at risk of sexually transmitted infections. Sexually Transmitted Diseases, 32, 7–12. doi: 10.1097/01.olq.0000148302.81575.fc.CrossRefPubMedGoogle Scholar
  23. Gorbach, P. M., Stoner, B. P., Aral, S. O., Whittington, W. L. H., & Holmes, K. K. (2002). “It takes a village”: Understanding concurrent sexual partnerships in Seattle, Washington. Sexually Transmitted Diseases, 29, 453–462. doi: 10.1097/00007435-200208000-00004.CrossRefPubMedGoogle Scholar
  24. Guzman, R., Colfax, G. N., Wheeler, S., Mansergh, G., Marks, G., Rader, M., et al. (2004). Negotiated safety relationships and sexual behavior among a diverse sample of HIV-negative men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 38, 82–86. doi: 10.1097/00126334-200501010-00015.Google Scholar
  25. Hallfors, D. D., Iritani, B. J., Miller, W. C., & Bauer, D. J. (2007). Sexual and drug behavior patterns and HIV and STD racial disparities: The need for new directions. American Journal of Public Health, 97, 125–132. doi: 10.2105/AJPH.2005.075747.CrossRefPubMedGoogle Scholar
  26. Harawa, N. T., Greenland, S., Bingham, T. A., Johnson, D. F., Cochran, S. D., Cunningham, W. E., et al. (2004). Associations of race/ethnicity with HIV prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United States. Journal of Acquired Immune Deficiency Syndromes, 35, 526–536. doi: 10.1097/00126334-200404150-00011.CrossRefPubMedGoogle Scholar
  27. Harawa, N. T., Greenland, S., Cochran, S. D., Cunningham, W. E., & Visscher, B. (2003). Do differences in relationship and partner attributes explain disparities in sexually transmitted disease among young White and Black women? Journal of Adolescent Health, 32, 187–191. doi: 10.1016/S1054-139X(02)00458-5.CrossRefPubMedGoogle Scholar
  28. Homans, G. C. (1958). Social behavior as exchange. American Journal of Sociology, 63, 597–606. doi: 10.1086/222355.CrossRefGoogle Scholar
  29. Jemmott, J. B., Jemmott, L. S., & Fong, G. T. (1992). Reductions in HIV risk-associated sexual behaviors among Black adolescents: Effects of an AIDS prevention. American Journal of Public Health, 82, 372–377.CrossRefPubMedGoogle Scholar
  30. Kalichman, S. C. (1996). Preventing AIDS: A sourcebook for behavioral interventions. Mahwah, NJ: Erlbaum.Google Scholar
  31. Kalichman, S. C., Cain, D., Weinhardt, L., Benotsch, E., Presser, K., Zweben, A., et al. (2005). Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients. Health Psychology, 24, 198–208. doi: 10.1037/0278-6133.24.2.198.CrossRefPubMedGoogle Scholar
  32. Kelly, J. A. (1995). Changing HIV risk behavior: Practical strategies. New York: Guilford Press.Google Scholar
  33. Kelly, J. A. (2004). Popular opinion leaders and HIV peer education: Resolving discrepant findings, and implications for the implementation of effective community programmes. AIDS Care, 16, 139–150. doi: 10.1080/09540120410001640986.CrossRefPubMedGoogle Scholar
  34. Kerrigan, D., Andrinopoulos, K., Johnson, R., Parham, P., Thomas, T., & Ellen, J. M. (2007). Staying strong: Gender ideologies among African-American adolescents and implications for HIV/STI prevention. Journal of Sex Research, 44, 172–180.PubMedGoogle Scholar
  35. Koumans, E. H., Farley, T. A., Gibson, J. J., Langley, C., Ross, M. W., McFarlane, M., et al. (2001). Characteristics of persons with syphilis in areas of persisting syphilis in the United States: Sustained transmission associated with concurrent partnerships. Sexually Transmitted Diseases, 28, 497–503. doi: 10.1097/00007435-200109000-00004.CrossRefPubMedGoogle Scholar
  36. Kraut-Becher, J. R., & Aral, S. O. (2003). Gap length: An important factor in sexually transmitted disease transmission. Sexually Transmitted Diseases, 30, 221–225. doi: 10.1097/00007435-200303000-00009.CrossRefPubMedGoogle Scholar
  37. Lambert, T. A., Kahn, A. S., & Apple, K. J. (2003). Pluralistic ignorance and hooking up. Journal of Sex Research, 40, 129–133.CrossRefPubMedGoogle Scholar
  38. Lane, S. D., Rubinstein, R. A., Keefe, R. H., Webster, N., Cibula, D. A., Rosenthal, A., et al. (2004). Structural violence and racial disparity in HIV transmission. Journal of Health Care for the Poor and Underserved, 15, 319–335. doi: 10.1353/hpu.2004.0043.CrossRefPubMedGoogle Scholar
  39. Lenoir, C. D., Adler, N. E., Borzekowski, D. L. G., Tschann, J. M., & Ellen, J. M. (2006). What you don’t know can hurt you: Perceptions of sex-partner concurrency and partner-reported behavior. Journal of Adolescent Health, 38, 179–185. doi: 10.1016/j.jadohealth.2005.01.012.CrossRefPubMedGoogle Scholar
  40. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.Google Scholar
  41. Manhart, L. E., Aral, S. O., Holmes, K. K., & Foxman, B. (2002). Sex partner concurrency: Measurement, prevalence, and correlates among urban 18–39-year-olds. Sexually Transmitted Diseases, 29, 133–143. doi: 10.1097/00007435-200203000-00003.CrossRefPubMedGoogle Scholar
  42. Marx, J. (2003). Season of life: A football star, a boy, a journey to manhood. New York: Simon & Schuster.Google Scholar
  43. McNair, L. D., & Prather, C. M. (2004). African American women and AIDS: Factors influencing risk and reaction to HIV disease. Journal of Black Psychology, 30, 106–123. doi: 10.1177/0095798403261414.CrossRefGoogle Scholar
  44. Miller, H. G., Cain, V. S., Rogers, S. M., Gribble, J. N., & Turner, C. F. (1999). Correlates of sexually transmitted bacterial infections among US women in 1995. Family Planning Perspectives, 31, 4–9 & 23.CrossRefPubMedGoogle Scholar
  45. Morris, M. (2001). Concurrent partnerships and syphilis persistence: New thoughts on an old puzzle. Sexually Transmitted Diseases, 28, 504–507. doi: 10.1097/00007435-200109000-00005.CrossRefPubMedGoogle Scholar
  46. Morris, M., & Kretzschmar, M. (1995). Concurrent partnerships and transmission dynamics in networks. Social Networks, 17, 299–318. doi: 10.1016/0378-8733(95)00268-S.CrossRefGoogle Scholar
  47. Nelson, S. J., Manhart, L. E., Gorbach, P. M., Martin, D. H., Stoner, B. P., Aral, S. O., et al. (2007). Measuring sex partner concurrency: It’s what’s missing that counts. Sexually Transmitted Diseases, 34, 801–807.PubMedGoogle Scholar
  48. Pilcher, C. D., Tien, H. C., Eron, J. J., Vernazza, P. L., Szu-Yun, L., Stewart, P. W., et al. (2004). Brief but efficient: Acute HIV infection and the sexual transmission of HIV. Journal of Infectious Diseases, 189, 1785–1792. doi: 10.1086/386333.CrossRefPubMedGoogle Scholar
  49. Potterat, J. J., Zimmerman-Rogers, H., Muth, S. Q., Rothenberg, R. B., Green, D. L., Taylor, J. E., et al. (1999). Chlamydia transmission: Concurrency, reproduction number, and the epidemic trajectory. American Journal of Epidemiology, 150, 1331–1339.PubMedGoogle Scholar
  50. Rosenberg, M. D., Gurvey, J. E., Adler, N. E., Dunlop, M. B. V., & Ellen, J. M. (1999). Concurrent sex partners and risk for sexually transmitted diseases among adolescents. Sexually Transmitted Diseases, 26, 208–212. doi: 10.1097/00007435-199904000-00004.CrossRefPubMedGoogle Scholar
  51. Rusbult, C. E. (1983). A longitudinal test of the investment model: The development (and deterioration) of satisfaction and commitment in heterosexual involvements. Journal of Personality and Social Psychology, 45, 101–117. doi: 10.1037/0022-3514.45.1.101.CrossRefGoogle Scholar
  52. Strauss, A., & Corbin, J. (1998). Basics of qualitative research. Thousand Oaks, CA: Sage.Google Scholar
  53. Tanfer, K., Cubbins, L. A., & Billy, J. O. G. (1995). Gender, race, class and self-reported sexually transmitted disease incidence. Family Planning Perspectives, 27, 196–202. doi: 10.2307/2136275.CrossRefPubMedGoogle Scholar
  54. Treadwell, H. M., & Ro, M. (2003). Poverty, race, and the invisible men. American Journal of Public Health, 93, 705–707.CrossRefPubMedGoogle Scholar
  55. Warner, L., Newman, D. R., Kamb, M. L., Fishbein, M., Douglas, J. M., Zenilman, J., et al. (2008). Problems with condom use among patients attending sexually transmitted disease clinics: Prevalence, predictors, and relation to incident gonorrhea and chlamydia. American Journal of Epidemiology, 167, 341–349. doi: 10.1093/aje/kwm300.CrossRefPubMedGoogle Scholar
  56. Watts, C. H., & May, R. M. (1992). The influence of concurrent partnerships on the dynamics of HIV/AIDS. Mathematical Biosciences, 108, 89–104. doi: 10.1016/0025-5564(92)90006-I.CrossRefPubMedGoogle Scholar
  57. Whitehead, T. L. (1997). Urban, low-income African American men, HIV/AIDS, and gender identity. Medical Anthropology Quarterly, 11, 411–447. doi: 10.1525/maq.1997.11.4.411.CrossRefPubMedGoogle Scholar
  58. Yach, D., McKee, M., Lopez, A. D., & Novotny, T. (2005). Improving diet and physical activity: 12 lessons from controlling tobacco smoking. British Medical Journal, 330, 898–900. doi: 10.1136/bmj.330.7496.898.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Michael P. Carey
    • 1
    Email author
  • Theresa E. Senn
    • 1
  • Derek X. Seward
    • 2
  • Peter A. Vanable
    • 1
  1. 1.Center for Health and BehaviorSyracuse UniversitySyracuseUSA
  2. 2.Counseling and Human DevelopmentUniversity of RochesterRochesterUSA

Personalised recommendations